Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm
Authors: Elisabeth C. McGowan, Monica McGrath, Andrew Law, T. Michael O’Shea, Judy L. Aschner, Courtney K. Blackwell, Rebecca C. Fry, Jody M. Ganiban, Rosemary Higgins, Amy Margolis, Sheela Sathyanarayana, Genevieve Taylor, Akram N. Alshawabkeh, José F. Cordero, Nicole T. Spillane, Mark L. Hudak, Carlos A. Camargo, Dana Dabelea, Anne L. Dunlop, Amy J. Elliott, Assiamira M. Ferrara, Maria Talavera-Barber, Anne Marie Singh, Margaret R. Karagas, Catherine Karr, Thomas G. O’Connor, Nigel Paneth, Rosalind J. Wright, Robert O. Wright, Whitney Cowell, Joseph B. Stanford, Casper Bendixsen, Barry M. Lester, Phillip B Smith, Laura K Newby, Lisa P Jacobson, Diane J Catellier, Richard C Gershon, David Cella, Susan L Teitelbaum, Annemarie Stroustrup, Andrea L Lampland, Dennis E Mayock, Lisa K Washburn, Cristiane Duarte, Glorisa J Canino, Alex Mason, Carmen J Marsit, Steven L Pastyrnak, Charles Neal, Jennifer B Helderman, Hyagriv Simhan, Jean Kerver, Charles Barone, Patricia McKane, Michael R Elliott, Susan L Schantz, Robert M Silver, Michelle Bosquet-Enlow, Stephanie L Merhar, Gloria S Pryhuber, Paul E Moore, Rajan Wadhawan, Carol L Wagner, Lisa A Croen, Lynne M Smith, Cindy McEvoy, Robert S Tepper, Leonardo Trasande, Clement L Ren, Anne Marie Reynolds, Roberta Keller, Andrea J Duncan, Jonathan M Mansbach, Jonathan M Spergel, Michelle D Stevenson, Cindy S Bauer, Sean CL Deoni, James E Gern, Edward M Zoratti, Leonard B Bacharier, George T O’Connor, Katherine Rivera-Spoljaric, Tina V Hartert, Christine C Johnson, Irva Hertz-Picciotto, Scott T Weiss, Robert Zeiger, Kristen Lyall, Rebecca Landa, Sally J Ozonoff, Stephen R Dager, Robert T Schultz, Joseph Piven, Heather Volk, Ruben Vaidya, Rawad Obeid, Caitlin Rollins, Kelly A Bear, Madeleine Lenski, Michael E Msall, Angela M Montgomery, Tracey J Woodruff, Christy A Porucznik, Elisabeth Conradt, R Keller, Carrie Breton, Theresa Bastain, Shohreh Farzan, Rima Habre, Rebecca Schmidt, Jean Frazier, Julie Herbstman
Journal: JAMA Network Open (2023)

Importance Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures Premature birth (&amp;amp;lt;37 weeks’ gestation). Main Outcomes and Measures The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks’ gestation) and differences among preterm subgroups of individuals (&amp;amp;lt;28 weeks’, 28-36 weeks’ vs ≥37 weeks’ gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks’ gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks’ gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19–related health care use may facilitate refinement of care models.